A systematic analysis of the literature comparing postoperative recovery after propofol, isoflurane, desflurane, and sevoflurane-based anesthesia in adults demonstrated that early recovery was faster in the desflurane and sevoflurane groups. The incidence of nausea and vomiting were less frequent with propofol.

Summary:the immaturity of the fetal immune system should allow transplanted foreign tissue to be accepted, avoiding the severe toxicities associated with BMT conditioning regimens. To date, in utero bone marrow transplantation (BMT) has had limited success, largely because of poor donorMoreover, in utero BMT should be feasible before the underlying disease can produce irreversible organ damage. engraftment. The poor engraftment is probably the result of performing the procedure late in gestation This is particularly important for BMT in the leukodystrophies, since only transplants done prior to the developafter significant fetal immunocompetence has developed and/or transplanting insufficient numbers of donor ment of significant neurologic damage appear to be efficacious. 1,2 To date, however, in utero BMT has had limited hematopoietic stem cells for competing successfully with ongoing fetal hematopoiesis. To overcome these probsuccess, largely because of poor donor engraftment. 3,4 This poor engraftment may be the result of performing the prolems, we performed in utero BMT on a fetus with globoid cell leukodystrophy during the first trimester of cedure late in gestation after significant immunocompetence has developed and/or transplanting insufficient numgestation using selected paternal bone marrow stem (CD34 + ) cells. CD34 selection allowed a substantially bers of donor hematopoietic stem cells (HSC) for competing successfully with ongoing host hematopoiesis. greater number of stem cells to be transplanted. Although the fetus died 7 weeks after the procedureWe performed in utero BMT on a fetus with globoid cell leukodystrophy early in gestation (the first trimester) using (during the 20th week of gestation), full donor engraftment was established. Moreover, the cause of selected parental bone marrow stem (CD34 + ) cells. Although the volume of marrow that can be transplanted death appeared to be overwhelming donor engraftment and leukostasis with paternal myeloid cells infiltrating into a first trimester fetus is limited, CD34 selection allowed transplantation of all the CD34 + marrow cells most tissues. The ability of in utero BMT to produce this degree of engraftment provides great promise for present in a full adult bone marrow harvest. Since CD34 is not expressed by immunocompetent T cells, this the use of this approach in the treatment of a variety of inherited disorders that can be diagnosed prenatally.approach also depleted T cells responsible for the development of graft-versus-host disease (GVHD).

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This study was designed to determine and compare the dose-response characteristics, speed of onset, and relative potency of single-dose epidural fentanyl (F) and sufentanil (S) for postoperative pain relief. Eighty women undergoing cesarean section (C/S) with epidural 2% lidocaine with epinephrine (1:200,000) were randomly assigned to receive double-blind epidural administration of F (25, 50, 100, or 200 microg) or S (5, 10, 20, or 30 microg) (n = 10 per group) upon complaint of pain postoperatively. Visual analog scales (VAS, 0-100 mm) were used to assess pain and sedation at baseline; at 3, 6, 9, 12, 15, 20, 25, 30, 45, and 60 min; and every 30 min until further analgesia was requested. The study was terminated at 30 min if satisfactory analgesia was not achieved. Side effects were recorded. A dose-response was demonstrated for both opioids. F 25 microg and S 5 microg were ineffective, with significantly fewer women achieving VAS scores <10 mm (P < 0.05 compared with F 100 or 200 microg and S 20 or 30 microg). F 100 and 200 microg and S 20 and 30 microg all achieved VAS scores <10 mm in all women with no differences in time to 50% reduction in VAS (mean 11-16 min) and no differences in duration of analgesia (mean 117-138 min). The 50% and 95% effective dose values for each opioid to achieve a VAS score <10 mm were F 33 microg and 92 microg and S 6.7 microg and 17.5 microg. There were no differences among groups in sedation scores or side effects. Our data suggest that the relative analgesic potency of epidural S:F is approximately 5 and that there are no differences between the opioids in the onset, duration, and effectiveness of analgesia when equianalgesic doses are administered postoperatively after lidocaine anesthesia for C/S.

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